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• W1602857584 abstract "An 80 year old woman presented as an emergency with a two week history of progressively worsening diffuse abdominal pain, bilious vomiting and diarrhoea. There was no history of trauma. She was commenced on Warfarin three weeks before this admission for paroxysmal atrial fibrillation. She previously had undergone a right hemicolectomy for poorly differentiated adenocarcinoma in 2008. Her past history was also significant for hypertension, chronic renal failure and breast cancer. Initial examination revealed normal vital signs. The abdomen was soft but diffusely tender, without guarding or rigidity. Normal bowel sounds were present. There was no lymphadenopathy. Blood tests revealed normal hemoglobin, renal and liver function tests. The International Normalised Ratio (INR) was 12.0. A supine abdominal X-ray was consistent with small bowel obstruction. A contrast-enhanced abdominal CT scan revealed concentric mural thickening of the proximal jejunum, extending distally from the duodenal-jejunal flexure for approximately 10 cm (Figure 1). The mesenteric changes adjacent to this were consistent with vascular interruption or bleed. The provisional diagnosis was a spontaneous intramural jejunal hematoma. The differential diagnosis included adenocarcinoma, lymphoma and metastatic cancer. The patient was managed conservatively with nil by mouth, intravenous fluids and analgesia. Her Warfarin was withheld. Vitamin K, prothrombinex and FFP were also given. Her symptoms gradually improved and she recommenced on a normal diet several days later. A follow-up abdominal CT scan at six weeks demonstrated complete resolution of the abnormality, thereby supporting the initial diagnosis of a bowel wall hematoma (Figure 2). Non-traumatic spontaneous intramural small bowel hematoma is a rare complication of anticoagulation with the majority of literature consisting of case reports. The incidence is estimated at 1/2500 patients on anticoagulants per year. Other risk factors include hemophilia, von Willebrand disease, Immune Thrombocytopenic Purpura, lymphoproliferative disorders, pancreatitis and pancreatic cancer. As is in this case, the jejunum is the most commonly affected region of the small bowel as opposed to the duodenum in traumatic causes. The exact reason for this is unknown, although the relative fixity of the jejunum to the ligament of Treitz has been implicated. Most non-traumatic spontaneous intramural SB hematoma resolve with conservative management and correction of the coagulopathy. Invasive procedures such as exploratory laparotomy are often reserved for cases complicated by bowel ischemia or those which do not resolve after a period of conservative management. Although small bowel haematoma is a rare cause for a common presentation of bowel obstruction, it should be considered as a differential diagnosis especially in patients who are on anticoagulation." @default.
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• W1602857584 date "2012-09-19" @default.
• W1602857584 modified "2023-10-16" @default.
• W1602857584 title "Gastrointestinal: Spontaneous jejunal hematoma secondary to supratherapeutic anticoagulation" @default.
• W1602857584 doi "https://doi.org/10.1111/j.1440-1746.2012.07230.x" @default.
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